Nearly 60% of COVID-19 spread may come from asymptomatic spread, model finds

How asymptomatic cases fuelled spread of coronavirus - Times of India

People with COVID-19 who don’t exhibit symptoms may transmit 59 percent of all virus cases, according to a model developed by CDC researchers and published Jan. 7 in JAMA Network Open. 

Since many factors influence COVID-19 spread, researchers developed a mathematical approach to assess several scenarios, varying the infectious period and proportion of transmission for those who never display symptoms according to published best estimates.  

In the baseline model, 59 percent of all transmission came from asymptomatic transmission. That includes 35 percent of new cases from people who infect others before they show symptoms and 24 percent from people who never develop symptoms at all. Under a broad range of values for each of these assumptions, at least 50 percent of new COVID-19 infections were estimated to have originated from exposure to asymptomatic individuals. 

The more contagious variant first identified in the U.K. and since found in six states underscores the importance of the model findings, said Jay Butler, MD, CDC deputy director for infectious diseases and a co-author of the study.

“Controlling the COVID-19 pandemic really is going to require controlling the silent pandemic of transmission from persons without symptoms,” Dr. Butler told The Washington Post. “The community mitigation tools that we have need to be utilized broadly to be able to slow the spread of SARS-CoV-2 from all infected persons, at least until we have those vaccines widely available.”

Whether vaccines stop transmission is still uncertain and was not a scenario addressed in the model. 

Banner Health halts elective surgeries

History

Banner Health will pause elective surgeries Jan. 1, the Phoenix-based system announced Dec. 30. 

The health system is suspending nonurgent elective surgeries that can reasonably be postponed for 30 to 60 days without a negative impact on the patient’s health, according to TV station CBS 5

Banner’s hospitals are facing a surge of COVID-19 patients. As of Dec. 29, the system was at 104 percent licensed bed capacity, Banner Chief Clinical Officer Marjorie Bessel, MD, said Dec. 30, according to TV station ABC 15. Some Banner hospitals have exceeded 120 percent licensed bed capacity.

Because of a backlog of patients, some Banner hospitals are diverting incoming ambulance transports. 

“This diversion activity is an early indication that triage may soon be necessary if volumes continue to increase like they did this past week,” Dr. Bessel said, according to CBS 5. “What triage would look like, would be that we might, if we got to that point, be unable to care for everybody.”

California reports first case of new coronavirus variant

https://www.axios.com/california-covid-coronavirus-variant-1081cbb4-5d2c-42f2-8785-b35e567296c9.html

California reported its first case of a new variant of the coronavirus that may be more transmissible, AP reports.

The big picture: California is the second state to document a confirmed case of the variant — which originated in the United Kingdom — after Colorado reported the first case in the United States on Tuesday.

  • California Gov. Gavin Newsom announced the infection during an online conversation with Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, according to AP.
  • The governor said the case was located in Southern California, but he did not provide any other details about the person who was infected.
  • “I don’t think Californians should think that this is odd. It’s to be expected,” Fauci said Wednesday, per AP.

Of note: There is thus far no evidence that the new variant is more deadly — only that it appears more transmissible. There is also no evidence that COVID-19 vaccines will be less effective against the new variant.

  • A non-peer reviewed study by the Centre for Mathematical Modelling of Infectious Diseases at the London School of Hygiene and Tropical Medicine found that the variant is 56% more transmissible than other strains.
  • The British government previously warned that a new variant could be up to 70% more transmissible.

Go deeper: What you need to know about the coronavirus mutation

Flying with covid-19 isn’t just reckless — it’s potentially deadly, doctors say

Covid-19 deaths on flights likely due to low cabin pressure, doctors say -  The Washington Post

Travelers boarding a flight during the pandemic might consider it unlikely that anyone sick with the coronavirus would make it onboard. But the reality is that travelers are boarding planes with covid-19, putting their fellow passengers at risk of contracting the illness.

Beyond the danger those infected passengers are creating to the people around them, they also pose a sizable risk to themselves when they board their planes. Doctors say that flying is a high-risk activity for coronavirus-positive individuals because of low air pressure in the cabin and that multiple passengers have now died because of it.

When a man infected with the coronavirus died of acute respiratory failure on a United Airlines flight from Orlando to Los Angeles on Dec. 14, he was not the first individual to die of covid-19 on a plane. In July, a Texas woman died of the disease on a Spirit Airlines flight that was diverted when she was found to be unresponsive and not breathing. In both cases, the passengers were given CPR on the plane but could not be revived.

The likely medical problem in both these instances, doctors say, is that low air pressure — which is standard in plane cabins — creates dangerously low blood-oxygen levels in people with respiratory conditions. Covid-19, the illness caused by the coronavirus, is a respiratory disease that often attacks the lungs and heart.

Nicholas Hill, pulmonary chief at Tufts Medical Center in Boston, says there is “no question” that the air condition in plane cabins poses a risk to passengers with covid-19 and that flying was probably factor in the deaths of the passengers infected with the virus.

“If you get on a plane with covid, or anything else respiratory-related, you are going to be at a considerably higher risk when you go to altitude,” Hill says. “This is not something unique to covid; it’s true of anybody that’s got an acute or respiratory condition. This change in oxygen from sea level can provoke crises in the air.”

Plane cabins are pressurized so passengers are able to breathe at altitudes over 30,000 feet, but the air pressure is still about 25 percent lower in a plane cabin than it is at sea level. Flying has long given respiratory-troubled patients medical crises in the air. Covid-19 is no different. Flying with it can impact blood oxygen levels to a degree that requires immediate medical attention.

David Freedman, an epidemiologist at the University of Alabama at Birmingham, says covid-infected patients are at the same risk as people with non-coronavirus lung and heart conditions that impact their breathing. Airlines are prepared for those kinds of respiratory emergencies with supplemental oxygen onboard.

“The oxygen concentration [on planes] is much lower than on the ground, and all patients with severe lung or heart disease know this and know that they will need supplemental oxygen on board even if they don’t require it normally,” Freedman says. “All planes do carry an oxygen tank on board for emergencies like this.”

Delta Air Lines says that respiratory emergencies make up about 10 percent of in-flight medical events and that all aircraft are equipped with supplemental oxygen.

All airline flight attendants receive annual training in CPR, Taylor Garland, a spokesperson for the Association of Flight Attendants labor union, told The Washington Post in an email. Flight crew are also in close contact with medical services on the ground that can meet the aircraft in the event of an emergency landing.

But those efforts all fell short in the July and December deaths. Hill says passengers do not necessarily need to be experiencing shortness of breath before takeoff to become breathing-impaired in-flight. Blood oxygen levels can be low in covid-19 patients who are not experiencing trouble breathing, making getting on a plane with the virus — even if you’re pre-symptomatic or asymptomatic — a high-risk endeavor.

“Early on in the pandemic there were descriptions of ‘happy hypoxia’ patients, covid patients who come in with pretty low oxygen levels but wouldn’t be short of breath,” Hill says. “Most people who have low oxygen levels are also complaining of shortness of breath, but it is possible initially to not have those symptoms.”

On the July Spirit Airlines flight, a crew member who administered CPR to the unresponsive woman passed out from exhaustion, according to reporting by The Post. Contact tracers reportedly never notified passengers on the plane of the positive coronavirus case onboard.

Tony Aldapa, an off-duty medical worker on the Dec. 14 United flight who gave chest compressions to the unresponsive man, said last week that he was experiencing coronavirus symptoms after helping the flight crew with CPR. He was not notified about his exposure to the virus by contact tracers until 10 days after the flight.

“I knew we were pretty far from where we needed to land at, and CPR is exhausting with one person or two people. Even with three or four people, it’s not an easy thing to do,” Aldapa, 31, told the Los Angeles Times of the incident. “Regardless of COVID … he needed CPR to save his life.”

Scripps CEO: Care rationing near if Californians ignore COVID-19 mitigation efforts

Prepare for Health Emergencies Like War Says CEO - Scripps Health

Hospitals in Southern California will need to start rationing care if more action isn’t taken by the community to mitigate the spread of COVID-19, Chris Van Gorder, president and CEO of Scripps Health, wrote in a Dec. 28 op-ed for The San Diego Union-Tribune

As of Dec. 29, 20,642 California residents were hospitalized with COVID-19. The state’s hospital bed capacity is 72,511. In San Diego County, where Scripps is headquartered, 18 intensive care unit beds were available as of Dec. 28, “not even enough to handle a single mass casualty incident,” Mr. Van Gorder wrote. Out of Scripps’ 173 ICU beds, seven staffed beds were available as of Dec. 28.

“This past weekend, one of our community hospitals ran out of room in their morgue. We are nearing the point where we have to make the decision of who gets care and who does not,” Mr. Van Gorder wrote.

He pleaded with the San Diego and California community to adhere to mask-wearing and social distancing guidelines, especially as the New Year’s Day holiday approaches. He called on residents to stay home for New Year’s, wear a mask, wash their hands, and not eat or drink with people who aren’t in their immediate family household.

Mr. Van Gorder’s commentary comes as Kaiser Permanente hospitals in Northern California are suspending elective, non-urgent procedures through Jan. 4 as they continue to face a surge in COVID-19 hospitalizations. The Oakland, Calif.-based system announced the suspension Dec. 26, days after Chair and CEO Greg Adams said during a news conference, “We simply will not be able to keep up if the COVID surge continues to increase. We’re at or near capacity everywhere.”

First case of highly infectious coronavirus variant detected in Colorado

Colorado officials on Tuesday reported the first known case in the United States of a person infected with the coronavirus variant that has been circulating rapidly across much of the United Kingdom and has led to a lockdown of much of southern England.

Scientists have said the variant is more transmissible but does not make people sicker.

The Colorado case involves a man in his 20s, who is in isolation in Elbert County, about 50 miles southeast of Denver, and has no travel history, according to a tweet from the office of Gov. Jared Polis (D).

“The individual has no close contacts identified so far but public health officials are working to identify other potential cases and contacts through thorough contact tracing interviews,” the statement said.

A federal scientist familiar with the investigation said the man’s lack of known travel — in contrast with most confirmed cases outside the United Kingdom — indicates this is probably not an isolated case. “We can expect that it will be detected elsewhere,” said the official, who spoke on the condition of anonymity to discuss the broader context of the announcement.

The Centers for Disease Control and Prevention confirmed as much in a statement Tuesday afternoon, saying additional cases with the new variant will be detected in the United States in coming days. The variant’s apparent increase in contagiousness “could lead to more cases and place greater demand on already strained health care resources,” the agency said in a statement.

Researchers have detected the more transmissible variant in at least 17 countries outside the United Kingdom, including as far away as Australia and South Korea, as of Tuesday afternoon. Officials in Canada had previously said they had identified two cases.

Although the U.K. variant appears more contagious, it is not leading to higher rates of hospitalizations or deaths, according to a report from Public Health England, a government agency. Nor is there any sign that people who were infected months ago with the coronavirus are more likely to be reinfected if exposed to the variant, according to the report. All available evidence indicates that vaccines, and immunity built up in the population, should be protective against this variant.

The Colorado case occurred in a county of about 27,000, which is currently classified, along with much of the state, in the “red” level for the virus, denoting serious but not extreme risk.

Two weeks ago, several hundred people gathered at a community church in the county seat of Kiowa to consider whether to pursue legal actions against Polis and other state officials for imposing coronavirus-related restrictions, according to the Elbert County News. County commissioners and the county sheriff have declined to enforce restrictions emanating from Denver.

“I was expecting to see it in ski country first because those areas are where people from across Colorado, the U.S. and internationally, gather,” said Elizabeth Carlton, an assistant professor of environmental and occupational health at the Colorado School of Public Health. The absence of any apparent travel history associated with the infected person, she said, suggests he “can’t be the only case in Colorado.”

Polis, in his statement, called on Coloradans to do everything they could to prevent transmission by wearing masks, standing six feet apart when gathering with others, and interacting only with members of their immediate households.

The arrival of the new variant “doesn’t fundamentally change the nature of the threat,” said Justin Lessler, an epidemiologist at Johns Hopkins Bloomberg School of Public Health. “It’s no more deadly than the virus was before, and it doesn’t look like it infects people who are immune.”

Lessler echoed others, saying he would be “astounded” if this was the only chain of transmission of the new variant in the United States. “We know that the virus spreads easily and quickly between countries,” he said, and the fact that the infected person had no travel history indicates “this strain has gotten here sometime in the past, and there are chains of transmission ongoing.”

The variant has a higher attack rate, according to the U.K. report, which bolsters the hypothesis that the variant has out-competed other versions of the coronavirus and is now the dominant variant across much of the United Kingdom. Among people known to have been exposed to someone already infected with the variant, 15.1 percent became infected. People exposed to someone infected with the non-variant version had a 9.8 percent infection rate.

That difference suggests the variant is more transmissible, though Public Health England said more investigation is needed to bolster the hypothesis.

The working theory among many scientists is that the increased transmissibility of the variant, known as B.1.1.7, is driven by mutations that have altered the spike protein on the surface of the virus. The variant has 17 mutations — eight of which alter the spike protein.

Precisely how those changes are leading to more infections is unknown. The virus may be binding more easily to receptor cells in the human body, or replicating more easily and driving higher viral loads, enhancing viral shedding by someone who is infected. Another possibility is that people are shedding the virus for a longer period, increasing the chances of passing it along.

“Preliminary evidence suggests that the new variant does not cause more severe disease or increased mortality,” Susan Hopkins, a senior medical adviser to Public Health England, said in a statement released Tuesday.

The newly published data echo the findings in a separate study published last week, based on modeling and hospitalization data — and not yet peer-reviewed — that estimated that the variant is 56 percent more transmissible but does not appear to alter the lethality of the virus.

“The good news is that B.1.1.7 does not seem to cause much more severe disease, and there’s no evidence that it is managing to evade the immune system, which means vaccines are expected to protect against it,” William Hanage, an epidemiologists at the Harvard T.H. Chan School of Public Health, said Tuesday after reviewing the new report. “The bad news is that B.1.1.7 does appear to be much more transmissible.”

Officials in the United States have been signaling since last week that the new variant was probably already present in this country.

“I’m not surprised,” Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said Tuesday. “I think we have to keep an eye on it, and we have to take it seriously. We obviously take any kind of mutation that might have a functional significance seriously. But I don’t think we know enough about it to make any definitive statements, except to follow it carefully and study it carefully.”

Research findings on coronavirus variants have been ambiguous at times, and scientists say they are still trying to extract reliable signals from noisy data. There have been several false alarms sounded about virus mutations in the past. A major challenge is discerning whether a virus variant is spreading rapidly because it has a competitive advantage based on genetic and structural differences, or because it is simply lucky, having arrived early to a location or leveraged a few superspreader events to gain dominance.

But with the United Kingdom seeing a severe winter surge of infections, public officials are taking no chances and have effectively locked down southern England, including London. Other countries have banned travelers from the United Kingdom.

The United States, despite having the world’s highest number of documented infections, has a weak track record in publishing genomic sequences, the process that enables researchers to track changes in the virus. Most sequences have been published by academic or private research institutions. By comparison, the United Kingdom has a national health system with a robust surveillance system.

“The U.K. made the decision in the spring to do this. The U.S. has sequencing equipment and infrastructure. As with many things in this pandemic, it was not executed the way it should have been,” said Neville Sanjana, a geneticist at New York University.

All viruses mutate randomly, and over time some of those mutations appear to confer some kind of advantage to the virus as it adapts to the human species. The novel coronavirus, SARS-CoV-2, mutates at a slow rate, and scientists do not think the genetic changes seen in the variant so far are sufficient to allow it to elude the vaccines now being administered to millions of people in many countries. But the coronavirus is a moving target and these mutations require surveillance.

Many scientists call the arrival of more transmissible mutations a wake-up call. “The lack of virus sequencing and case tracking in the USA is a scandal,” said Jeremy Luban, a virologist at the University of Massachusetts Medical School.

Francois Balloux, who directs the Genetics Institute at University College London, on Twitter predicted that within two weeks, enough data will accumulate to determine whether this new variant is indeed more transmissible. Previously, Balloux and his colleagues combed through genome sequences, looking for evidence that common variants had increased transmissibility.

“We don’t see much,” he said, referring to a report published in the journal Nature in November that found no signs of mutations that helped the virus to spread more easily. However, he said he “wouldn’t underestimate the evolutionary potential of SARS-CoV-2.”

Biden to address nation on pandemic as Fauci says coronavirus surge ‘has just gotten out of control’

Fauci: U.S. may see “surge upon surge” of coronavirus in weeks ahead – The  Denver Post

President-elect Joe Biden plans to deliver an address on the coronavirus pandemic as the nation experiences what his chief medical adviser on the issue, Anthony S. Fauci, described Tuesday as a surge in cases “that has just gotten out of control in many respects.”

Biden’s remarks, planned Tuesday afternoon in Wilmington, Del., are expected to be his most extensive comments to date since early this month, when he laid out a plan for his first 100 days in office that included imploring all Americans to wear masks.

Fauci, appearing on CNN on Tuesday morning, lamented what he expects to be a post-holiday increase in cases and the strong possibility than January’s caseload will exceed even that of December. “You just have to assume it’s going to get worse,” Fauci said.

Fauci also acknowledged that the rollout of vaccines was not reaching as many Americans as quickly as the 20 million that Trump administration had pledged by the end of the month.

“We certainly are not at the numbers that we wanted to be at the end of December,” said Fauci, director of the National Institute of Allergy and Infectious Diseases. “We are below where we want to be.”

But Fauci, who accepted Biden’s invitation to play an expanded role in his administration, expressed hope that by “showing leadership from the top,” Biden could make an impact — comments that appeared to be implicit criticism of President Trump, who has said little publicly about the crisis since Election Day.

“What he’s saying is that let’s take at least 100 days and everybody, every single person put aside this nonsense of making masks be a political statement or not,” Fauci said of Biden. “We know what works. We know social distancing works. We know avoiding congregant settings works. For goodness sakes, let’s all do it, and you will see that curve will come down.”

Separately Tuesday, Vice President-elect Kamala D. Harris plans to get vaccinated in Washington. Biden received his first shot last week.

In remarks earlier this month, Biden also pledged to distribute 100 million vaccine shots in his first 100 days in office and said he wanted to open as many schools safely during the period as possible. He has also promised to sign an executive order requiring masks to be worn on federal property.

On Monday, Celine Gounder, a member of Biden’s covid-19 advisory board, said during a television appearance that Biden is also considering invoking the Defense Production Act to increase production of coronavirus vaccines,

Appearing on CNBC’s “Squawk Box,” Grounder said Biden could invoke the wartime-production law “to make sure the personal protective equipment, the test capacity and the raw materials for the vaccines are produced in adequate supply.”

During his CNN appearance, Fauci said that getting children back to school safely should remain an imperative, despite rising caseloads.

“You can’t have one size fits all, but the bottom line, what I call default position, should be that wherever we are, try as best as we can to get the children back to school and to keep them in school and to have a plan to try and keep them as safe as possible,” he said.

About 200,000 new coronavirus cases have been reported daily in recent weeks, with a record high of 252,431 on Dec. 17.

The nation’s overall caseload surpassed 19 million Sunday, even as the holidays were expected to cause a lag in reporting. Hospitalizations have exceeded 100,000 since the start of December and hit a peak of 119,000 on Dec. 23. Deaths are averaging more than 2,000 a day, with the most ever reported — 3,406 fatalities — on Dec. 17.

Kaiser Permanente halts elective surgeries at some California hospitals

Vigil outside Kaiser honors suicide victims denied mental health care –  SFBay

Twenty-one Kaiser Permanente hospitals in Northern California are suspending elective, non-urgent procedures through Jan. 4 as they continue to face a surge in COVID-19 hospitalizations, according to The Mercury News.

The Oakland, Calif.-based system announced the suspension Dec. 26, days after Chairman and CEO Greg Adams said during a news conference, “We simply will not be able to keep up if the COVID surge continues to increase. We’re at or near capacity everywhere.”

California reported a record-high 20,059 current COVID-19 hospitalizations Dec. 27, a 13 percent increase from one week prior, according to The COVID Tracking Project.

Find a running list of other health systems that have adjusted their elective surgery timelines, organized by state, here

1 of every 17 people in the U.S. has been infected, and 1 in 1,000 has died. Yet the worst may lie ahead.

1 of every 17 people in the U.S. has been infected, and 1 in 1,000 has died.  Yet the worst may lie ahead. - The New York Times

With bubble-enclosed Santas and Zoom-enhanced family gatherings, much of the United States played it safe over Christmas while the coronavirus rampaged across the country.

But a significant number of Americans traveled, and uncounted gatherings took place, as they will over the New Year holiday.

And that, according to the nation’s top infectious disease expert, Anthony S. Fauci, could mean new spikes in cases, on top of the existing surge.

“We very well might see a post-seasonal — in the sense of Christmas, New Year’s — surge,” Dr. Fauci said on CNN’s “State of the Union.”

“We’re really at a very critical point,” he said. “If you put more pressure on the system by what might be a post-seasonal surge because of the traveling and the likely congregating of people for, you know, the good warm purposes of being together for the holidays, it’s very tough for people to not do that.”

On “Fox News Sunday,” Adm. Brett P. Giroir, the administration’s testing coordinator, noted that Thanksgiving travel did not lead to an increase of cases in all places, which suggested that many people heeded recommendations to wear masks and limit the size of gatherings.

“It really depends on what the travelers do when they get where they’re going,” Admiral Giroir said. “We know the actual physical act of traveling in airplanes, for example, can be quite safe because of the air purification systems. What we really worry about is the mingling of different bubbles once you get to your destination.”

Still, U.S. case numbers are about as high as they have ever been. Total infections surpassed 19 million on Saturday, meaning that at least 1 in 17 people have contracted the virus over the course of the pandemic. And the virus has killed more than 332,000 people — one in every thousand in the country.

Two of the year’s worst days for deaths have been during the past week. A number of states set death records on Dec. 22 or Dec. 23, including Alabama, Wisconsin, Arizona and West Virginia, according to The Times’s data.

And hospitalizations are hovering at a pandemic height of about 120,000, according to the Covid Tracking Project.

Against that backdrop, millions of people in the United States have been traveling, though many fewer than usual.

About 3.8 million people passed through Transportation Safety Administration travel checkpoints between Dec. 23 and Dec. 26, compared with 9.5 million on those days last year. Only a quarter of the number who flew on the day after Christmas last year did so on Friday, and Christmas Eve travel was down by one-third from 2019.

And AAA’s forecast that more than 81 million Americans would travel by car for the holiday period, from Dec. 23 to Jan. 3, which would be about one-third fewer than last year.

For now, the U.S. is no longer seeing overall explosive growth, although California’s worsening outbreak has canceled out progress in other parts of the country. The state has added more than 300,000 cases in the seven-day period ending Dec. 22. And six Southern states have seen sustained case increases in the last week: Tennessee, Alabama, Georgia, South Carolina, Florida and Texas.

Holiday reporting anomalies may obscure any post-Christmas spike until the second week of January. Testing was expected to decrease around Christmas and New Year’s, and many states said they would not report data on certain days.

On Christmas Day, numbers for new infections, 91,922, and deaths, 1,129, were significantly lower than the seven-day averages. But on Saturday, new infections jumped past 225,800 new cases and deaths rose past 1,640, an expected increase over Friday as some states reported numbers for two days post-Christmas.

The deadliest year in U.S. history didn’t have to be so deadly

If you decided to read the names of every American who is known to have died of covid-19, the disease caused by the novel coronavirus, at a rate of one per second starting at 5 p.m. Tuesday, you would not finish until a bit after 10 a.m. Saturday. Except, of course, that’s only including the deaths known as of writing; by then, we can expect 8,000 more deaths, pushing the recitation past noon.

Preliminary federal figures indicate that more than 3.2 million Americans will die over the course of 2020, the highest figure on record. It’s just a bit shy of 1 percent of the total population as of July 1, and about 1 in 10 of those deaths will be a result of covid-19.

That’s the primary context in which any discussion about how the pandemic has affected the United States should occur. Secondarily, we should consider how the number of new coronavirus infections correlates to that figure. At the moment, nearly two people are dying of covid-19 each minute, a function of a massive surge in the number of new infections that began in mid-September.

The surge and the deaths are inextricable. For months, the number of new deaths on any given day has been about 1.8 percent of new cases several weeks prior. Allowing the virus to spread wildly means allowing more Americans to die.

In an opinion piece for the Wall Street Journal, one of the architects of the decision to let the virus spread, former White House adviser Scott Atlas, blames the scale of the pandemic on the media. It’s the “politicization” of the virus, he argues, that has led to the dire outcomes we see, and that’s largely due to “media distortion.”

It’s hard to overstate both how dishonest Atlas’s argument is and how ironic it is that he should point the blame elsewhere. He makes false assertions about where states have been successful and suggests that mitigation efforts that weren’t 100 percent effective shouldn’t be used. He boasts that the effort to combat the spread of the virus was left to states — which is precisely the criticism aimed at President Trump’s administration. When Trump (and Atlas) undercut efforts to slow the spread of the virus, Trump supporters — including state leaders — picked up on that approach, contributing to the current spread.

Trump and Atlas shared the view that allowing the virus to spread was beneficial, as doing so increased population immunity. That another result would be surging deaths was met with a shrug or silence.

At the end of March, Trump offered one of his only forceful endorsements of slowing the spread of the virus. Having been presented with research indicating that as many as 2.2 million Americans would die of the virus if no effort was taken to limit its spread, he endorsed stay-at-home measures aimed at preventing new infections. His team suggested that implementing such mitigation efforts would keep the death toll under 240,000, with the added benefit of preventing hospitals from being overwhelmed.

This was one of Atlas’s arguments, too: Let the virus spread but backstop hospitals to prevent them from being flooded. The government accomplished the first goal, at least.

So we’ve raced past the 240,000-death mark, passing 300,000 deaths this month.

It’s important to remember, too, how often Trump himself promised this wasn’t going to be the country’s future. As the virus was spreading without detection — in part thanks to the Centers for Disease Control and Prevention’s failure to develop a working test — Trump repeatedly downplayed how bad things would get. There were thousands of deaths around the world, he noted in early March, but less than a dozen in the United States. He compared the coronavirus to the seasonal flu and to the H1N1 pandemic in 2009, an event that had the politically useful characteristic of having occurred while Trump’s eventual opponent in the presidential election was vice president.

Over and over, Trump predicted a high-water mark for coronavirus deaths. Over and over, the country surged past his predictions. As the election approached, he began simply comparing the death toll to that 2.2-million-death figure he’d first introduced in March.

The United States will not reach 2.2 million coronavirus deaths over the course of the pandemic. We probably won’t reach 500,000, assuming that the national vaccination effort — the far-safer way to spread immunity — progresses without significant problems.

Right now, though, thousands of people are dying every day and tens of thousands more are on an inevitable path to the same result. More robust efforts to prevent new infections could have reduced these numbers, as robust efforts did elsewhere (contrary to Atlas’s theories). A consistent, forceful message from a president whose base is devoutly supportive of him would unquestionably have reshaped the virus’s spread. Had Trump embraced the expertise of government virologists, instead of a radiologist he saw on Fox News, it would have perhaps pushed the curve depicting the number of deaths each day back down instead of driving it higher.

This was the deadliest year in American history. Perhaps it would inevitably have been, given the size of the population (particularly the elderly population) and the emergence of covid-19. But it unquestionably didn’t have to be as deadly as it was.